Arrival
Park in the visitor’s parking lot and use the front entrance of the hospital. Follow the blue lines on the floor and posted signs to the second-floor elevator. Take the elevator to the Surgical Admissions nursing station on the second floor. Family members can then go to the surgical waiting area. Your surgeon will meet with your family in the waiting room when the procedure is complete.
Surgical Admission
In Surgical Admissions, you will be prepared for surgery. Any final instructions will be given to you and any questions you have will be answered. You will change out of your street clothes and into a hospital gown. Your belongings will be taken to your room on the third floor.
Pre-Surgical Holding Area
Here, an IV will be started. Antibiotics and blood thinners will be administered, and your skin will be prepared with cleansers to decrease the risk of infection. Your operating room nurse and anesthesiologist will interview you. They will go over your health record, and confirm your consent for surgery. You may be asked the same questions five or six times, so try to be patient. Each person responsible for your care will ask these same questions. They are crosschecking to make sure all your information is correct.
Next, you will be escorted to the operating room where you will see your surgeon, if you did not yet see him or her. You will be asked to move from the gurney onto the operating table. The nurse may put a safety belt across your abdomen as a precaution. You will be asked to breathe oxygen through a mask to increase the amount of oxygen in your body before the anesthesia is administered. When you are ready, the anesthesiologist will inject medication into your IV and you will go to sleep.
After you fall asleep, the anesthesiologist will have you inhale anesthetic gases and will then insert a tube down your throat and into your airway. Muscle relaxers are given, and a machine breathes for you. The anesthesiologist monitors your blood pressure, pulse rate, respiratory rate, muscle tension and blood oxygen levels continuously during surgery.
Operation
After you are asleep, the nurses and technicians position your body on the operating table, and prepare your skin with a special antiseptic to decrease the chance of infection. Sterile surgical drapes will be placed over your body, leaving only a small window over the abdomen through which the operation will be performed. What happens in the operating suite depends on the type of surgery you are having.
If you are having an open operation, an incision will be made from the lower end of the sternum (breast bone), directly downward for up to 10 inches. It is deepened through the fatty tissue over the front of the abdomen, down through the tendon-like fascia, which holds the muscles of the abdomen together. Once the abdomen is open, you surgeon will check all the organs to be sure that there are no unexpected abnormalities. If anything unexpected is found, the surgeon will make a decision on what to do to correct it on your behalf.
If your surgery is done laparoscopically, a small incision is made above the belly button, and a special spring-loaded needle is inserted. Carbon dioxide gas is blown through this needle until the abdomen is inflated like a balloon. Next, more small incisions are made in the abdomen to allow insertion of the necessary tools. Laproscopic gastric bypass surgery uses techniques that allow the operation to be done without a large incision.
The most challenging part of the laproscopic operation is reaching the upper portion of the stomach, which lies high up in the abdomen, behind the liver. This is where the connection (anastamosis) is made between the small stomach pouch and the small intestine. During the open operation, the stitches are placed by hand, using long instruments that allow reaching into the abdomen 10-12- inches. Laparoscopically, this connection is made with specialized staples, which are reinforced by hand suturing.
Normally the connection can be made secure and watertight. Generally a drain is inserted in this area as a precaution and as a way to monitor for the integrity of the connection. The drain may be left in place for a few days after your discharge from the hospital.
After the open operation, the incision is closed with suture that restores the abdominal fascia to its correct anatomical position, to decrease the chance of hernias. The skin is then closed with absorbable suture that are hidden just beneath the surface. The top layer of skin is usually closed with staples. A dressing is applied and taped in place. You will probably have an abdominal binder resembling a corset over your dressing.
After the laproscopic operation, the small incisions are closed with suture hidden underneath the skin as well. The skin surface may be closed with staples, steri-strips, or dermabond. Sometimes small bandages are applied over each incision site.
Recovery Room
Following surgery, you will begin to awaken in the recovery room area (PACU). When you are awake enough to breathe on your own, the tube in your throat will be removed. You will have oxygen on, delivered by mask or nasal tubes. You will also have heart monitor pads on your chest and a pulse monitor on your finger.
Begin moving your feet when you wake up. Start taking deep breaths through your nose and exhaling through your mouth.
You will remain in the PACU for one to two hours where you will be closely monitored. During this time, pain control will be established and your vital signs will be monitored. Your PACU nurse will also make sure that you are not nauseated and are breathing without difficulty. You will then be taken your room on the third floor.
On the Floor
Most discomfort occurs within the first 12 hours following surgery, so you will receive pain medication through your IV via a patient-controlled analgesia pump (PCA). The machine will not allow an overdose to occur and keeps track of the number of times the button is pushed and the total amount of narcotic administered.
The nurses will be in your room frequently to check your vital signs. They will repeatedly remind you to move your feet and ankles, breathe deeply, cough and use your Incentive Spirometer. It is important that you begin doing this immediately, to prevent pneumonia. You will also be asked to change positions in bed frequently. You may be asked to stand and even walk the day of surgery.
You will not be able to eat or drink anything the day of surgery. If your mouth is dry, ask your nurse for mouth swabs to moisten your mouth and lips. You can bring lip balm to the hospital with you if you wish.
Family and Friends
Sometimes, surgery does not start on time, or may take longer than expected. These situations are not cause for alarm. The actual surgery does not take place for at least an hour after admission to the hospital. Family should expect word about three to four hours after the scheduled time of your operation. Your doctor will try to contact family in the surgery waiting room after the operation. Your family and friends will be allowed to see you after you are brought to your room on the third floor.
